Intradermal (i.d.) application of vaccine is promising way how to induce specific immune response against particular pathogens. Adjuvants, substances added into vaccination dose with the aim to ...increase immunogenicity, play important role in activation of dendritic cells with subsequent activation of lymphocytes. They can, however, induce unwanted local reactions. The aim of the study was to determine the effect of i.d. administration of model antigen keyhole limped hemocyanine alone or with different adjuvants-aluminium hydroxide and oil-based adjuvants-on local histopathological reaction as well as dendritic cell activation at the site of administration and local cytokine and chemokine response. This was assessed at 4 and 24 hours after application. Selection of the adjuvants was based on the fact, that they differently enhance antibody or cell-mediated immunity. The results showed activation of dendritic cells and both Th1 and Th2 response stimulated by oil-based adjuvants. It was associated with higher expression of set of genes, incl. chemokine receptor CCR7 or Th1-associated chemokine CXCL10 and cytokine IFNγ. Application of the antigen with aluminium hydroxide induced higher expression of Th2-associated IL4 or IL13. On the other hand, both complete and incomplete Freund´s adjuvants provoked strong local reaction associated with influx of neutrophils. This was accompanied with high expression of proinflammatory IL1 or neutrophil chemoattractant CXCL8. Surprisingly, similarly strong local reaction was detected also after application of aluminium hydroxide-based adjuvant. The best balanced local reaction with sufficient activation of immune cells was detected after application of oil-based adjuvants Montanide and Emulsigen.
Uvod: Postoperativna bol nakon velike ortopedske kirurgije izuzetno je jaka, posebno nakon re- vizijske operacije, gdje je uništavanje kostiju opsežno. Uloga postoperativne analgezije vrlo je važna. ...U tu se svrhu obično koriste opioidni analgetici u kontinuiranoj infuziji u kombinaciji s intravenskom primjenom paracetamola, metamizola i ketoprofena.
Materijali i metode: Pacijent je primljen na revizijsku operaciju nakon ugradnje totalne endopro- teze kuka. Pacijent je alergičan na većinu analgetskih lijekova uključujući fentanil, alfentanil, tra- madol, buprenorfin, paracetamol, piroksikam, propifenazon, kodein, kofein, diklofenak, ibuprofen. Samo su Ketoprofen i Oxycodonum dopušteni analgetici. U ovom je slučaju postoperativna analgezi- ja bila teška zbog vrlo uskog izbora analgetika. Istraživači su primijenili regionalni bedreni bedreni živac u kombinaciji s akupunkturom uha na bojnom polju, koja ima izražen analgosedativni učinak. Bol se mjerila audiovizualnom skalom i dodavali dopušteni analgetici po potrebi
Rezultati: Pacijent je bio zadovoljan postignutom analgezijom i izbjegnute su nuspojave analgetika. Zaključci: Akupunktura uha Battelfield u kombinaciji s blokadom živaca vrlo je učinkovita metoda u liječenju postoperativne boli u velikim ortopedskim operacijama.
Prikazujemo svoje iskustvo u anesteziranju bolesnika s osteogenesis imperfectom u sklopu ortopedskoga kirurškog liječenja prijeloma i deformacija kostiju. Učinjena je retrospektivna analiza ...dokumentacije bolesnika liječenih u našoj Klinici od 1980. do 2012. godine. Analizirani su demografski podaci, komorbiditeti, prijeoperacijske osobitosti, vrste anestezije, anestetika i lijekova te intraoperacijske i poslijeoperacijske komplikacije. U navedenom razdoblju liječeno je 26 bolesnika s navedenom dijagnozom. Zabilježene su 103 operacije, odnosno 103 anesteziološka postupka. Najviše zahvata, njih 68, učinjeno je u dobnoj skupini od 0 do 10 godina. Najviše bolesnika bolovalo je od tipa III osteogenesis imperfecte, najtežeg oblika ove bolesti spojivog sa životom. U 99 operacija zabilježen je ASA (American society of anesthesiologists) status II bolesnika. U 89 slučajeva učinjena je opća anestezija, u 14 regionalna. Zabilježeno je 14 intraoperacijskih komplikacija, najviše otežanih intubacija te 6 slučajeva poslijeoperacijske kardiovaskularne nestabilnosti. Uz kvalitetnu pripremu i predviđanje mogućih komplikacija anestezija u ovih bolesnika sigurna je procedura.
The aim is to show our experience in anesthesia of patients with osteogenesis imperfecta (OI) who have undergone orthopedic surgical procedures. This is a retrospective analysis of OI patients ...treated at our Department from 1980 to 2012. We analyzed demographics, comorbidities, preoperative characteristics, anesthesia types, anesthetics and intraoperative and postoperative complications. In the given period, 26 OI patients were treated, using 103 surgeries, and 103 anesthesia procedures. Most procedures, a total of 68, were used in children aged 0-10 years. According to the diagnosis, OI type III was mostly encountered. The rating of the American Society of Anesthesiologist (ASA) physical status was II in most cases, a total of 99. General anesthesia was used in 89 cases, and regional anesthesia in 14. Fourteen intraoperative complications were seen, mostly difficult intubation, and six postoperative cardiovascular instability cases. With careful preparation, and knowledge of pitfalls, anesthesia in these patients should be a safe procedure.
The effects of intradermal application of antigen with or without different adjuvants and activation of immune response are presented in this study. Six groups of six piglets each were immunized with ...keyhole limpet haemocyanin (KLH) antigen in combination with aluminium hydroxide or oil-based adjuvants (complete and incomplete Freund's adjuvants, Montanide ISA 206 and Emulsigen). IgG1 and IgG2 levels in sera were measured by KLH-specific ELISA. Interestingly, oil-based adjuvants induced high primary IgG2 response, suggesting the Th1 lymphocyte polarization. Also, considering the similarities between human and porcine organism, we suggest that intradermal application could be considered as an effective vaccine delivery route in both veterinary and human medicine.
•Although intradermal application has many advantages, it is still seldom used.•Adjuvants are used in vaccine to influence quantity and quality of immune response.•Our results show that oil-based adjuvants enhances Th1 response with IgG2 isotype.
Route of vaccine delivery can greatly impact the immunogenicity, efficacy and safety of the vaccine. Four groups of piglets were immunised transdermally (t.d.), intradermally (i.d.) or ...intramuscularly (i.m.) with the same doses of antigen in combination with a water-in-oil-in-water emulsion adjuvant Montanide™ ISA 201 VG or with a microemulsion adjuvant Montanide™ IMS 1313 VG N ST (Seppic, France). The last group was left without vaccination as a control group. All animals were subsequently exposed to the infection induced by Actinobacillus pleuropneumoniae (App). The immune response was evaluated with respect to the intensity of systemic and mucosal antibody formation, their isotype characterisation and rate of cell-mediated immunity. These findings were compared with the intensity of adverse local reactions and level of protection in experimental challenge. Monitoring of the local reaction at the injection site after each administration showed that microemulsion adjuvant IMS 1313 was less reactogenic than the water-in-oil-in-water emulsion ISA 201. In terms of efficacy, both dermal administrations were less immunogenic than the i.m route. The i.m. injection induced higher anti-App9 IgG and IgM titres. Nevertheless, IgG1 and IgG2 isotypes analysis revealed a close immunological profile between i.m. and i.d. routes. The concentration of IFN-γ from peripheral blood after in vitro restimulation with the specific antigen was only increased in the i.m. group at the day of challenge (D35) and two weeks after (D49). Interestingly, the smallest gross pulmonary lesions were observed in the i.d. vaccinated group (3.4%) compared to the control group (39.4%) and to groups with other routes of administration. Taken together, these results suggest that i.d. administration of vaccines is a promising approach. Even the i.d. vaccine was more reactogenic and slightly less immunogenic than the i.m. vaccine, its protection effectiveness seemed to be superior.
•Transdermal and intradermal application was compared to intramuscular one.•Water-in-oil-in-water emulsion was compared to microemulsion adjuvant•Model of porcine pleuropneumoniae was used.•Intensity of antibody production and cell-mediated immunity was measured.•Systemic as well as local immunity was considered.•Protection induced by vaccination was assessed by challenge infection.•Intradermal application led to the best protection.
Introduction: The advantage of intrathecal morphine is due to its delivery into the subarachnoid space with direct access to opiate receptors and ion channels, while clinical duration of action can ...be as long as 20 hours. Joint replacement surgery is reported to be one of the most painful surgical procedures. The key factor for short postoperative length of stay and rapid functional recovery is pre-operative, intraoperative and postoperative analgesia. Spinal anaesthesia incorporating intrathecal morphine has been used as a systemic opioid-sparing technique. The most frequently investigated dose of intrathecal morphine was 100 μg.
Materials and Methods: In this study, spinal anaesthesia with the addition of morphine for intrathecal administration at a dose of 200 μg and 250 μg was administered to patients who underwent surgery for total hip arthroplasty and VAS pain scale was monitored postoperatively in the next 24 hours. The study group was compared to a group of patients who received standard intravenous analgesia postop- eratively.
Results: Intrathecal application of morphine improves pain management in the first 24 postoperative hours in comparison to a control group who has received a systemic combination of opioid and non- opioid analgesics as part of postoperative analgesia.
Conclusions: The use of intrathecal morphine at a dose of 200 μg or 250 μg is an extremely good anal- gesic method in the postoperative period after surgery for total hip arthroplasty.
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